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Marrero N, Jha K, Hughes TM, Razavi AC, Grant JK, Boakye E, Anchouche K, Dzaye O, Budoff MJ, Rotter JI, Guo X, Yao J, Wood AC, Blumenthal RS, Michos ED, Thanassoulis G, Post WS, Blaha MJ, Ibeh C, Whelton SP. Association of aortic valve calcium with dementia and stroke: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2024:117596. [PMID: 38890039 DOI: 10.1016/j.atherosclerosis.2024.117596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND AND AIMS Calcific aortic valve disease is associated with increased thrombin formation, platelet activation, decreased fibrinolysis, and subclinical brain infarcts. We examined the long-term association of aortic valve calcification (AVC) with newly diagnosed dementia and incident stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AVC was measured using non-contrast cardiac CT at Visit 1. We examined AVC as a continuous (log-transformed) and categorical variable (0, 1-99, 100-299, ≥300). Newly diagnosed dementia was adjudicated using International Classification of Disease codes. Stroke was adjudicated from medical records. We calculated absolute event rates (per 1000 person-years) and multivariable adjusted Cox proportional hazards ratios (HR). RESULTS Overall, 6812 participants had AVC quantified with a mean age of 62.1 years old, 52.9 % were women, and the median 10-year estimated atherosclerotic cardiovascular disease (ASCVD) risk was 13.5 %. Participants with AVC >0 were older and less likely to be women compared to those with AVC=0. Over a median 16-year follow-up, there were 535 cases of dementia and 376 cases of stroke. The absolute risk of newly diagnosed dementia increased in a stepwise pattern with higher AVC scores, and stroke increased in a logarithmic pattern. In multivariable analyses, AVC was significantly associated with newly diagnosed dementia as a log-transformed continuous variable (HR 1.09; 95 % CI 1.04-1.14) and persons with AVC ≥300 had nearly a two-fold higher risk (HR 1.77; 95 % CI 1.14-2.76) compared to those with AVC=0. AVC was associated with an increased risk of stroke after adjustment for age, sex, and race/ethnicity, but not after adjustment for ASCVD risk factors. CONCLUSIONS After multivariable adjustment, AVC >0 was significantly associated with an increased risk of newly diagnosed dementia, but not incident stroke. This suggests that AVC may be an important risk factor for the long-term risk of dementia beyond traditional ASCVD risk factors.
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Affiliation(s)
- Natalie Marrero
- University of Miami/Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kunal Jha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; University of Louisville, Division of Cardiology, Louisville, KY, USA
| | - Timothy M Hughes
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center for Heart Disease Prevention, Emory School of Medicine, Atlanta, GA, USA
| | - Jelani K Grant
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Khalil Anchouche
- Preventive and Genomic Cardiology, Department of Medicine, McGill University, and the McGill University Health Center Research Institute, Montréal, Québec, Canada
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - George Thanassoulis
- Preventive and Genomic Cardiology, Department of Medicine, McGill University, and the McGill University Health Center Research Institute, Montréal, Québec, Canada
| | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chinwe Ibeh
- Columbia University, Department of Neurology, New York, NY, USA
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Geng C, Meng K, Tang Y. Identifying the mediating role of inflammation on the relationship between socioeconomic status and Alzheimer's disease: a Mendelian randomization analysis and mediation analysis. J Neurol 2024; 271:2484-2493. [PMID: 38253907 DOI: 10.1007/s00415-023-12176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Observational studies have demonstrated a significant association between socio-economic status (SES) and Alzheimer's disease (AD). Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian Randomization (MR) approach to investigate the causal relationship between SES and genetic susceptibility to AD, as well as to explore the potential mediation effects of inflammation. METHODS Large-scale cohorts based on publicly available genome-wide association study (GWAS) datasets from European populations were employed for conducting the MR study. The primary criterion utilized was the inverse-variance weighting (IVW) model. Heterogeneity and horizontal pleiotropy were assessed. In addition, multivariate MR (MVMR) was utilized to correct the confounders. Moreover, a two-step MR approach was used to evaluate the potential mediating effects of factors on the causal effects between SES and AD. RESULTS As indicated by the results of the IVW model, educational years (OR = 0.708, 95% CI 0.610-0.821, P < 0.001) and household income (OR = 0.746, 95% CI 0.566-0.982, P = 0.037) was associated with a decreased genetic susceptibility risk for AD. The univariable results showed that the causal effect of educational years on the lower risk of AD remained significant (OR = 0.643, 95% CI 0.467-0.886, P = 0.006). In addition, our findings indicated that C-reactive protein (CRP) played a role in the causal effect of educational years on AD. The proportions of mediation were - 50.08% (95% CI - 92.78; - 7.38%). DISCUSSION These findings provided evidence supporting the causal effect of educational attainment lower AD risk, with inflammation playing a mediating role. These findings may inform prevention strategies and interventions directed toward AD. Future studies should explore other plausible biological mechanisms.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Ke Meng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Yi Tang
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- Neurodegenerative Laboratory of Ministry of Education of the People's Republic of China, Beijing, China.
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Godard-Sebillotte C, Navani S, Hacker G, Vedel I. Considering inequities in national dementia strategies: breadth, depth, and scope. Int J Equity Health 2024; 23:75. [PMID: 38627768 PMCID: PMC11022480 DOI: 10.1186/s12939-024-02166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address challenges posed by the disease. These strategies aim to improve the care, support, and resources available to meet the needs of persons living with dementia and their care partners and communities. Despite the known impact of social determinants of health on dementia risk, care, and outcomes, it is unclear whether dementia strategies adequately address related inequities. This study aimed to describe whether and how national dementia strategies considered inequities associated with social determinants of health. METHODS We conducted an environmental scan of the national dementia strategies of countries that are part of the Organisation for Economic Cooperation and Development (OECD). Included strategies had to be accessible in English or French. Sub-national or provincial plans were excluded. We synthesised information on strategies' considerations of inequity through a thematic analysis. RESULTS Of the 15 dementia strategies that met inclusion criteria, 13 mentioned at least one inequity (M = 2.4, median = 2, range:0-7) related to Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Age and disability were mentioned most frequently, and religion most infrequently. Eleven strategies included general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage changes, deadlines, or allocated budgets for achieving equity-related goals outlined in their strategies. CONCLUSIONS Understanding if and how countries consider inequities in their dementia strategies enables the development of future strategies that adequately target inequities of concern. While most of the strategies mentioned inequities, few included tangible objectives to reduce them. Countries must not only consider inequities at a surface-level; rather, they must put forth actionable objectives that intend to lessen the impact of inequities in the care of all persons living with dementia.
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Affiliation(s)
- Claire Godard-Sebillotte
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Department of Medicine, Division of Geriatrics, McGill University, Montreal, QC, Canada.
| | - Sanjna Navani
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Georgia Hacker
- The Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Isabelle Vedel
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Abo Hamza E, Tindle R, Pawlak S, Bedewy D, Moustafa AA. The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework. Rev Neurosci 2024; 0:revneuro-2023-0163. [PMID: 38607658 DOI: 10.1515/revneuro-2023-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.
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Affiliation(s)
- Eid Abo Hamza
- College of Education, Humanities & Social Sciences, 289293 Al Ain University , 64141, Al Jimi, UAE
- Faculty of Education, Tanta University, Al-Geish St., 122011, Tanta, Egypt
| | - Richard Tindle
- JMS Allied Services, 1109 Coffs Harbour , NSW, 2452, Australia
| | - Simon Pawlak
- Department of Psychological Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC 3122, Australia
| | - Dalia Bedewy
- Department of Psychology, College of Humanities and Sciences, 59104 Ajman University , University Street, Al jerf 1, Ajman, UAE
- Department of Psychology, Faculty of Education, Tanta University, Al-Geish St., 122011, Tanta, Egypt
- 59104 Humanities and Social Sciences Research Center (HSSRC), Ajman University , University Street, Al jerf 1, Ajman, UAE
| | - Ahmed A Moustafa
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Cnr Kingsway & University Roads, Auckland Park, Johannesburg, 2092, South Africa
- School of Psychology, Faculty of Society and Design, 448704 Bond University , 14 University Dr, Robina QLD 4226, Gold Coast, QLD, Australia
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Li D, Zhou L, Cao Z, Wang J, Yang H, Lyu M, Zhang Y, Yang R, Wang J, Bian Y, Xu W, Wang Y. Associations of environmental factors with neurodegeneration: An exposome-wide Mendelian randomization investigation. Ageing Res Rev 2024; 95:102254. [PMID: 38430933 DOI: 10.1016/j.arr.2024.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Neurodegenerative diseases (NDDs) remain a global health challenge. Previous studies have reported potential links between environmental factors and NDDs, however, findings remain controversial across studies and elusive to be interpreted as evidence of robust causal associations. In this study, we comprehensively explored the causal associations of the common environmental factors with major NDDs including Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), based on updated large-scale genome-wide association study data through two-sample Mendelian randomization (MR) approach. Our results indicated that, overall, 28 significant sets of exposure-outcome causal association evidence were detected, 12 of which were previously underestimated and newly identified, including average weekly beer plus cider intake, strenuous sports or other exercises, diastolic blood pressure, and body fat percentage with AD, alcohol intake frequency with PD, apolipoprotein B, systolic blood pressure, and forced expiratory volume in 1 s (FEV1) with ALS, and alcohol intake frequency, hip circumference, forced vital capacity, and FEV1 with MS. Moreover, the causal effects of several environmental factors on NDDs were found to overlap. From a triangulation perspective, our investigation provided insights into understanding the associations of environmental factors with NDDs, providing causality-oriented evidence to establish the risk profile of NDDs.
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Affiliation(s)
- Dun Li
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhi Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jida Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Hongxi Yang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Mingqian Lyu
- Department of Computer Science, RWTH Aachen University, Aachen, 52062, Germany
| | - Yuan Zhang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Rongrong Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Ju Wang
- School of Biomedical Engineering, Tianjin Medical University, Tianjin 300070, China
| | - Yuhong Bian
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society Karolinska Institutet and Stockholm University, Stockholm 171 65, Sweden
| | - Yaogang Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; School of Public Health, Tianjin Medical University, Tianjin 300070, China; Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; National Institute of Health Data Science at Peking University, Peking University, Beijing 100191, China.
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Couret A, Lapeyre-Mestre M, Renoux A, Gardette V. Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort. Front Public Health 2024; 12:1284542. [PMID: 38487186 PMCID: PMC10937384 DOI: 10.3389/fpubh.2024.1284542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pluriprofessional and coordinated healthcare use is recommended for Alzheimer's Disease and Related Diseases (ADRD). Despite a protective health system, France is characterized by persistent and significant social inequalities in health. Although social health inequalities are well documented, less is known about social disparities in healthcare use in ADRD, especially in France. Therefore, this study aimed to describe healthcare use according to socioeconomic deprivation among ADRD subjects and the possible potentiating role of deprivation by age. Methods We studied subjects identified with incident ADRD in 2017 in the French health insurance database (SNDS). We described a large extent of their healthcare use during the year following their ADRD identification. Deprivation was assessed through French deprivation index (Fdep), measured at the municipality level, and categorized into quintiles. We compared healthcare use according to the Fdep quintiles through chi-square tests. We stratified the description of certain healthcare uses by age groups (40-64 years, 65-74 years, 75-84 years, 85 years, and older), number of comorbidities (0, 1, 2-3, 4 comorbidities and more), or the presence of psychiatric comorbidity. Results In total, 124,441 subjects were included. The most deprived subjects had less use of physiotherapy (28.56% vs. 38.24%), ambulatory specialists (27.24% vs. 34.07%), ambulatory speech therapy (6.35% vs. 16.64%), preventive consultations (62.34% vs. 69.65%), and were less institutionalized (28.09% vs. 31.33%) than the less deprived ones. Conversely, they were more exposed to antipsychotics (11.16% vs. 8.43%), benzodiazepines (24.34% vs. 19.07%), hospital emergency care (63.84% vs. 57.57%), and potentially avoidable hospitalizations (12.04% vs. 10.95%) than the less deprived ones. Discussion and conclusion The healthcare use of subjects with ADRD in France differed according to the deprivation index, suggesting potential health renunciation as in other diseases. These social inequalities may be driven by financial barriers and lower education levels, which contribute to health literacy (especially for preventive care). Further studies may explore them.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS “Pharmacologie En Population cohorteS et biobanqueS,” Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
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Ye S, Roccati E, Wang W, Zhu Z, Kiburg K, Huang Y, Zhang X, Zhang X, Liu J, Tang S, Hu Y, Ge Z, Yu H, He M, Shang X. Leading determinants of incident dementia among individuals with and without the apolipoprotein E ε4 genotype: a retrospective cohort study. BMC Neurol 2024; 24:71. [PMID: 38378514 PMCID: PMC10877929 DOI: 10.1186/s12883-024-03557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Little is known regarding the leading risk factors for dementia/Alzheimer's disease (AD) in individuals with and without APOE4. The identification of key risk factors for dementia/Alzheimer's disease (AD) in individuals with and without the APOE4 gene is of significant importance in global health. METHODS Our analysis included 110,354 APOE4 carriers and 220,708 age- and sex-matched controls aged 40-73 years at baseline (between 2006-2010) from UK Biobank. Incident dementia was ascertained using hospital inpatient, or death records until January 2021. Individuals of non-European ancestry were excluded. Furthermore, individuals without medical record linkage were excluded from the analysis. Moderation analysis was tested for 134 individual factors. RESULTS During a median follow-up of 11.9 years, 4,764 cases of incident all-cause dementia and 2065 incident AD cases were documented. Hazard ratios (95% CIs) for all-cause dementia and AD associated with APOE4 were 2.70(2.55-2.85) and 3.72(3.40-4.07), respectively. In APOE4 carriers, the leading risk factors for all-cause dementia included low self-rated overall health, low household income, high multimorbidity risk score, long-term illness, high neutrophil percentage, and high nitrogen dioxide air pollution. In non-APOE4 carriers, the leading risk factors included high multimorbidity risk score, low overall self-rated health, low household income, long-term illness, high microalbumin in urine, high neutrophil count, and low greenspace percentage. Population attributable risk for these individual risk factors combined was 65.1%, and 85.8% in APOE4 and non-APOE4 carriers, respectively. For 20 risk factors including multimorbidity risk score, unhealthy lifestyle habits, and particulate matter air pollutants, their associations with incident dementia were stronger in non-APOE4 carriers. For only 2 risk factors (mother's history of dementia, low C-reactive protein), their associations with incident all-cause dementia were stronger in APOE4 carriers. CONCLUSIONS Our findings provide evidence for personalized preventative approaches to dementia/AD in APOE4 and non-APOE4 carriers. A mother's history of dementia and low levels of C-reactive protein were more important risk factors of dementia in APOE4 carriers whereas leading risk factors including unhealthy lifestyle habits, multimorbidity risk score, inflammation and immune-related markers were more predictive of dementia in non-APOE4 carriers.
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Affiliation(s)
- Siting Ye
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, 7001, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia
| | - Katerina Kiburg
- Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xueli Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Xiayin Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jiahao Liu
- Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia
| | - Shulin Tang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, VIC, 3800, Australia
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
- Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
| | - Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
- Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia.
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC, 3050, Australia.
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Park SY, Setiawan VW, Crimmins EM, White LR, Wu AH, Cheng I, Darst BF, Haiman CA, Wilkens LR, Le Marchand L, Lim U. Racial and Ethnic Differences in the Population-Attributable Fractions of Alzheimer Disease and Related Dementias. Neurology 2024; 102:e208116. [PMID: 38232335 PMCID: PMC11097758 DOI: 10.1212/wnl.0000000000208116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies estimated that modifiable risk factors explain up to 40% of the dementia cases in the United States and that this population-attributable fraction (PAF) differs by race and ethnicity-estimates of future impact based on the risk factor prevalence in contemporary surveys. The aim of this study was to determine the race-specific and ethnicity-specific PAF of late-onset Alzheimer disease and related dementias (ADRDs) based on the risk factor prevalence and associations observed on the same individuals within a prospective cohort. METHODS Data were from Multiethnic Cohort Study participants (African American, Japanese American, Latino, Native Hawaiian, and White) enrolled in Medicare Fee-for-Service. We estimated the PAF based on the prevalence of risk factors at cohort baseline and their mutually adjusted association with subsequent ADRD incidence. Risk factors included low educational attainment and midlife exposures to low neighborhood socioeconomic status, unmarried status, history of hypertension, stroke, diabetes or heart disease, smoking, physical inactivity, short or long sleep duration, obesity, and low-quality diet, as well as APOE ε4 for a subset. RESULTS Among 91,881 participants (mean age 59.3 at baseline, 55.0% female participants), 16,507 incident ADRD cases were identified from Medicare claims (1999-2016, mean follow-up 9.3 years). The PAF for nongenetic factors combined was similar in men (24.0% [95% CI 21.3-26.6]) and women (22.8% [20.3-25.2]) but varied across Japanese American (14.2% [11.1-17.2]), White (21.9% [19.0-24.7]), African American (27.8% [22.3-33.0]), Native Hawaiian (29.3% [21.0-36.7]), and Latino (33.3% [27.5-38.5]) groups. The combined PAF was attenuated when accounting for competing risk of death, in both men (10.4%) and women (13.9%) and across racial and ethnic groups (4.7%-25.5%). The combined PAF was also different by age at diagnosis and ADRD subtypes, higher for younger (65-74 years: 43.2%) than older (75-84 years: 32.4%; ≥85 years: 11.3%) diagnoses and higher for vascular or unspecified ADRD than for AD or Lewy body dementia. An additional PAF of 11.8% (9.9-13.6) was associated with APOE ε4, which together with nongenetic risk factors accounted for 30.6% (25.8-35.1) of ADRD. DISCUSSION Known risk factors explained about a third of the ADRD cases but with unequal distributions across racial and ethnic groups.
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Affiliation(s)
- Song-Yi Park
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Veronica Wendy Setiawan
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Eileen M Crimmins
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Lon R White
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Anna H Wu
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Iona Cheng
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Burcu F Darst
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Christopher A Haiman
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Lynne R Wilkens
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Loїc Le Marchand
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
| | - Unhee Lim
- From the Population Sciences in the Pacific Program (S.-Y.P., L.R. Wilkens, L.L.M., U.L.), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu; Department of Population and Public Health Sciences (V.W.S., A.H.W., C.A.H.), Keck School of Medicine and Norris Comprehensive Cancer Center, and Leonard Davis School of Gerontology (E.M.C.), Andrus Gerontology Center, University of Southern California, Los Angeles; Pacific Health Research and Education Institute (L.R. White), Honolulu, HI; Department of Epidemiology and Biostatistics (I.C.), University of California, San Francisco; and Public Health Sciences Division (B.F.D.), Fred Hutchinson Cancer Center, Seattle, WA
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9
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Oh TK, Song IA. Impact of prescribed opioid use on development of dementia among patients with chronic non-cancer pain. Sci Rep 2024; 14:3313. [PMID: 38331973 PMCID: PMC10853162 DOI: 10.1038/s41598-024-53728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
We aimed to examine the association between opioid use and the development of dementia in patients with chronic non-cancer pain in South Korea. Data were extracted from the National Health Insurance Service database in South Korea. Adult patients diagnosed with musculoskeletal diseases with chronic non-cancer pain between 2010 and 2015 were included in the analysis. Patients who were prescribed opioids regularly and continuously for ≥ 90 days were classified as opioid users. In total, 1,261,682 patients with chronic non-cancer pain were included in the final analysis, of whom 21,800 (1.7%) were opioid users. From January 1, 2016 to December 31, 2020, 35,239 (2.8%) patients with chronic non-cancer pain were newly diagnosed with dementia. In the multivariable model, opioid users showed a 15% higher risk of developing dementia than the control group. Additionally, opioid users showed a 15% and 16% higher risk of developing Alzheimer's disease and unspecified dementia, respectively, than the control group, but did not show any significant differences for vascular dementia. Among adult patients with chronic non-cancer pain, opioid users were at a higher risk of developing dementia than the control group; the risk was significantly higher for Alzheimer's disease but not for vascular dementia in this study. Our results suggest that in patients with CNCP, public health strategies should target opioid users for early dementia detection and intervention.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
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10
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Matsuda S, Yoshimura H. Dental decision-making for persons with dementia: A systematic narrative review. Medicine (Baltimore) 2024; 103:e36555. [PMID: 38241530 PMCID: PMC10798713 DOI: 10.1097/md.0000000000036555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/17/2023] [Indexed: 01/21/2024] Open
Abstract
Dental decision-making represents the establishment of a common understanding between the dental professional and the recipient of the intervention, which determines oral healthcare and dental treatment policies. Dental decision-making for persons with dementia can be challenging, and there have been no systematic reviews on this topic. Therefore, this systematic narrative review aimed to identify the current state of dental decision-making in persons with dementia. Literature search was performed using PubMed, Web of Science, Cochrane Library, CINAHL, and Google Scholar databases. Through the process of research selection, 7 articles with a high risk of bias were included in this study. This review clarified that there is limited information on the dental decision-making processes for persons with dementia. In conclusion, although this may be difficult due to different medical and socioeconomic conditions, the dilemma between the need to establish evidence for dental decision-making and medical ethics that prioritize a patient-centered position should be discussed globally in the future.
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Affiliation(s)
- Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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11
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Kang HS, Kim JH, Kim JH, Bang WJ, Choi HG, Kim NY, Park HY, Kwon MJ. Unlocking the Protective Potential of Upper Respiratory Infection Treatment Histories against Alzheimer's Disease: A Korean Adult Population Study. J Clin Med 2024; 13:260. [PMID: 38202267 PMCID: PMC10780066 DOI: 10.3390/jcm13010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
With increasing interest in the inflammation-pathogen infection hypothesis and its potential links to Alzheimer's disease (AD) development, there is growing consideration of using upper respiratory infection (URI) treatments as interventions for AD. This nested case-control study explored the potential association between prior URI histories and AD development in a Korean adult population using the national health screening cohort data (2002-2019). The study included 26,920 AD patients and 107,680 matched control individuals, focusing on those seeking respiratory treatment. Logistic regression analyses assessed the impact of URI histories and treatment on AD risk while adjusting for covariates. Our results revealed that over a 1-year period, individuals with URI histories (≥1, ≥2, or ≥3 instances) exhibited decreasing probabilities of developing AD, with risk reductions of 19%, 15%, and 12%, respectively. Expanding our investigation to a 2-year period consistently showed a 17% reduction in AD risk. This effect remained robust across diverse demographic groups and after adjusting for covariates, encompassing comorbidities, hypertension, hyperlipidemia, blood glucose levels, and lifestyle factors. Subgroup analyses further substantiated this association. In conclusion, our findings cautiously suggest a potential protective role of prior URI treatment histories in mitigating the risk of AD development.
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Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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12
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Hinojosa-Gonzalez DE, Zafar A, Saffati G, Kronstedt S, Zlatev DV, Khera M. Androgen deprivation therapy for prostate cancer and neurocognitive disorders: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00785-w. [PMID: 38167924 DOI: 10.1038/s41391-023-00785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Prostate cancer is a prevalent disease that urgently needs to address its treatment-related complications. By examining existing evidence on the association between Androgen Deprivation Therapy (ADT) and dementia, this study contributes to the understanding of potential risks. We sought to analyze the currently available evidence regarding the risk of dementia, Alzheimer's disease (AD), vascular dementia, and Parkinson's disease (PD) in patients undergoing ADT. METHODS A systematic search of PubMed, EMBASE, Scopus, and Google Scholar was performed to identify studies published from the databases' inception to April 2023. Studies were identified through systematic review to facilitate comparisons between studies with and without some degree of controls for biases affecting distinctions between ADT receivers and non-ADT receivers. This review identified 305 studies, with 28 meeting the inclusion criteria. Heterogeneity was assessed using Higgins I2%. Variables with an I2 over 50% were considered heterogeneous and analyzed using a Random-Effects model. Otherwise, a Fixed-Effects model was employed. RESULTS A total of 28 studies were included for analysis. Out of these, only 1 study did not report the number of patients. From the remaining 27 studies, there were a total of 2,543,483 patients, including 900,994 with prostate cancer who received ADT, 1,262,905 with prostate cancer who did not receive ADT, and 334,682 patients without prostate cancer who did not receive ADT. This analysis revealed significantly increased Hazard Ratios (HR) of 1.20 [1.11, 1.29], p < 0.00001 for dementia, HR 1.26 [1.10, 1.43], p = 0.0007 for Alzheimer's Disease, HR 1.66 [1.40, 1.97], p < 0.00001 for depression, and HR 1.57 [1.31, 1.88], p < 0.00001 for Parkinson's Disease. The risk of vascular dementia was HR 1.30 [0.97, 1.73], p < 0.00001. CONCLUSION Based on the analysis of the currently available evidence, it suggests that ADT significantly increases the risk of dementia, AD, PD, and depression.
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Affiliation(s)
- David E Hinojosa-Gonzalez
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA.
| | - Affan Zafar
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Gal Saffati
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Shane Kronstedt
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
| | - Dimitar V Zlatev
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Mohit Khera
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA
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Bransby L, Rosenich E, Maruff P, Lim YY. How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors. J Prev Alzheimers Dis 2024; 11:22-37. [PMID: 38230714 PMCID: PMC10995020 DOI: 10.14283/jpad.2023.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/06/2023] [Indexed: 01/18/2024]
Abstract
Many risk factors for dementia, identified from observational studies, are potentially modifiable. This raises the possibility that targeting key modifiable dementia risk factors may reduce the prevalence of dementia, which has led to the development of dementia risk reduction and prevention strategies, such as intervention trials or dementia prevention guidelines. However, what has rarely been considered in the studies that inform these strategies is the extent to which modifiable dementia risk factors can (1) be identified by individuals, and (2) be readily modified by individuals. Characteristics of modifiable dementia risk factors such as readiness of identification and targeting, as well as when they should be targeted, can influence the design, or success of strategies for reducing dementia risk. This review aims to develop a framework for classifying the degree of modifiability of dementia risk factors for research studies. The extent to which these modifiable dementia risk factors could be modified by an individual seeking to reduce their dementia risk is determined, as well as the resources that might be needed for both risk factor identification and modification, and whether modification may be optimal in early-life (aged <45 years), midlife (aged 45-65 years) or late-life (aged >65 years). Finally, barriers that could influence the ability of an individual to engage in risk factor modification and, ultimately, dementia risk reduction are discussed.
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Affiliation(s)
- L Bransby
- Lisa Bransby, Turner Institute for Brain and Mental Health, 18 Innovation Walk, Clayton, VIC 3800, Australia;
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14
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Park YS, Joo HJ, Jang YS, Jeon H, Park EC, Shin J. Socioeconomic Status and Dementia Risk Among Intensive Care Unit Survivors: Using National Health Insurance Cohort in Korea. J Alzheimers Dis 2024; 97:273-281. [PMID: 38143351 DOI: 10.3233/jad-230715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND In aging populations, more elderly patients are going to the intensive care unit (ICU) and surviving. However, the specific factors influencing the occurrence of post-intensive care syndrome in the elderly remain uncertain. OBJECTIVE To investigate the association between socioeconomic status (SES) and risk of developing dementia within two years following critical care. METHODS This study included participants from the Korean National Health Insurance Service Cohort Database who had not been diagnosed with dementia and had been hospitalized in the ICU from 2003 to 2019. Dementia was determined using specific diagnostic codes (G30, G31) and prescription of certain medications (rivastigmine, galantamine, memantine, or donepezil). SES was categorized into low (medical aid beneficiaries) and non-low (National Health Insurance) groups. Through a 1:3 propensity score matching based on sex, age, Charlson comorbidity index, and primary diagnosis, the study included 16,780 patients. We used Cox proportional hazard models to estimate adjusted hazard ratios (HR) of dementia. RESULTS Patients with low SES were higher risk of developing dementia within 2 years after receiving critical care than those who were in non-low SES (HR: 1.23, 95% CI: 1.04-1.46). Specifically, patients with low SES and those in the high-income group exhibited the highest incidence rates of developing dementia within two years after receiving critical care, with rates of 3.61 (95% CI: 3.13-4.17) for low SES and 2.58 (95% CI: 2.20-3.03) for high income, respectively. CONCLUSIONS After discharge from critical care, compared to the non-low SES group, the low SES group was associated with an increased risk of developing dementia.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hye Jin Joo
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Seoul, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hajae Jeon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Gjøra L, Strand BH, Bergh S, Bosnes I, Johannessen A, Livingston G, Skjellegrind HK, Selbæk G. Prevalence and Determinants of Diagnosed Dementia: A Registry Linkage Study Linking Diagnosis of Dementia in the Population-Based HUNT Study to Registry Diagnosis of Dementia in Primary Care and Hospitals in Norway. J Alzheimers Dis 2024; 99:363-375. [PMID: 38701153 DOI: 10.3233/jad-240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background A timely diagnosis of dementia can be beneficial for providing good support, treatment, and care, but the diagnostic rate remains unknown and is probably low. Objective To determine the dementia diagnostic rate and to describe factors associated with diagnosed dementia. Methods This registry linkage study linked information on research-based study diagnoses of all-cause dementia and subtypes of dementias, Alzheimer's disease, and related dementias, in 1,525 participants from a cross-sectional population-based study (HUNT4 70+) to dementia registry diagnoses in both primary-care and hospital registries. Factors associated with dementia were analyzed with multiple logistic regression. Results Among those with research-based dementia study diagnoses in HUNT4 70+, 35.6% had a dementia registry diagnosis in the health registries. The diagnostic rate in registry diagnoses was 19.8% among home-dwellers and 66.0% among nursing home residents. Of those with a study diagnosis of Alzheimer's disease, 35.8% (95% confidence interval (CI) 32.6-39.0) had a registry diagnosis; for those with a study diagnosis of vascular dementia, the rate was 25.8% (95% CI 19.2-33.3) and for Lewy body dementias and frontotemporal dementia, the diagnosis rate was 63.0% (95% CI 48.7-75.7) and 60.0% (95% CI 43.3-75.1), respectively. Factors associated with having a registry diagnosis included dementia in the family, not being in the youngest or oldest age group, higher education, more severe cognitive decline, and greater need for help with activities of daily living. Conclusions Undiagnosed dementia is common, as only one-third of those with dementia are diagnosed. Diagnoses appear to be made at a late stage of dementia.
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Affiliation(s)
- Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Ingunn Bosnes
- Department of Psychiatry, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Aud Johannessen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Håvard Kjesbu Skjellegrind
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Christian LM, Wilson SJ, Madison AA, Prakash RS, Burd CE, Rosko AE, Kiecolt-Glaser JK. Understanding the health effects of caregiving stress: New directions in molecular aging. Ageing Res Rev 2023; 92:102096. [PMID: 37898293 PMCID: PMC10824392 DOI: 10.1016/j.arr.2023.102096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Dementia caregiving has been linked to multiple health risks, including infectious illness, depression, anxiety, immune dysregulation, weakened vaccine responses, slow wound healing, hypertension, cardiovascular disease, metabolic syndrome, diabetes, frailty, cognitive decline, and reduced structural and functional integrity of the brain. The sustained overproduction of proinflammatory cytokines is a key pathway behind many of these risks. However, contrasting findings suggest that some forms of caregiving may have beneficial effects, such as maintaining caregivers' health and providing a sense of meaning and purpose which, in turn, may contribute to lower rates of functional decline and mortality. The current review synthesizes these disparate literatures, identifies methodological sources of discrepancy, and integrates caregiver research with work on aging biomarkers to propose a research agenda that traces the mechanistic pathways of caregivers' health trajectories with a focus on the unique stressors facing spousal caregivers as compared to other informal caregivers. Combined with a focus on psychosocial moderators and mechanisms, studies using state-of-the-art molecular aging biomarkers such as telomere length, p16INK4a, and epigenetic age could help to reconcile mixed literature on caregiving's sequelae by determining whether and under what conditions caregiving-related experiences contribute to faster aging, in part through inflammatory biology. The biomarkers predict morbidity and mortality, and each contributes non-redundant information about age-related molecular changes -together painting a more complete picture of biological aging. Indeed, assessing changes in these biopsychosocial mechanisms over time would help to clarify the dynamic relationships between caregiving experiences, psychological states, immune function, and aging.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Stephanie J Wilson
- Department of Psychology, Southern Methodist University, University Park, TX, USA
| | - Annelise A Madison
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Ruchika S Prakash
- Department of Psychology, The Ohio State University, Columbus, OH, USA; Center for Cognitive and Behavioral Brain Imaging, Ohio State University, Columbus, OH, USA
| | - Christin E Burd
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Ashley E Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Li R, Li R, Xie J, Chen J, Liu S, Pan A, Liu G. Associations of socioeconomic status and healthy lifestyle with incident early-onset and late-onset dementia: a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e693-e702. [PMID: 38042162 DOI: 10.1016/s2666-7568(23)00211-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Modifiable risk factor estimates are sparse for early-onset dementia incidence. This study aimed to estimate and compare the risk factor profiles of early-onset dementia and late-onset dementia, and to explore the complex relationships between socioeconomic status, lifestyles, and early-onset dementia risk. METHODS In this prospective cohort study, we used data from the UK Biobank for analysis of early-onset dementia and late-onset dementia. For early-onset dementia analyses, data were collected on those aged younger than 60 years without prevalent dementia at baseline. For late-onset dementia analyses, data were collected on those aged 65 years or older at the end of follow-up. Participants with missing information on socioeconomic factors were excluded. Two models were used to test associations between early-onset dementia incidence and socioeconomic status. The first model tested associations between socioeconomic status and early-onset and late-onset dementia incidence, adjusting for covariates. Participant socioeconomic status was defined using education level, income, and employment status via latent class analysis. The second model additionally included a healthy lifestyle score, which was constructed using data on smoking, alcohol consumption, physical activity, and the Healthy Diet Index. Incident early-onset dementia was defined as a dementia case diagnosed before 65 years of age. Multivariable-adjusted Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for risk of dementia. We used multivariable-adjusted Cox proportional-hazard regression models to estimate the HR for risk of both early-onset dementia and late-onset dementia. FINDINGS Between 2007 and 2010, 257 345 individuals were included in the analysis of early-onset dementia, and 294 133 older individuals were included in the analysis of late-onset dementia. During a mean follow-up of 11·9-12·5 years, 502 early-onset dementia cases and 5768 late-onset dementia cases were documented. Risk factor profiles were typically dissimilar between early-onset dementia and late-onset dementia. For instance, the age and sex adjusted HR for low socioeconomic status (vs high) was 4·40 (95% CI 3·43-5·65) for early-onset dementia and 1·90 (1·74-2·07) for late-onset dementia, yielding a ratio of HRs of 2·32 (1·78-3·02). After adjusting for various risk factors, participants with low socioeconomic status (vs high) had increased risk for early-onset dementia (3·38, 2·61-4·37), and overall lifestyle mediated 3·2% (1·8-5·7) of the association. Individuals with both low socioeconomic status and unhealthy lifestyles had a higher risk of early-onset dementia (5·40, 3·66-7·97). No significant interaction was observed between lifestyle and socioeconomic status. The association between socioeconomic status and early-onset dementia seemed to be more pronounced in individuals with type 2 diabetes (HR 11·21, 95% CI 2·70-46·57). INTERPRETATION Early-onset dementia and late-onset dementia might have different risk factor profiles; although risk factors were similar, the magnitude of associations between risk factors and dementia incidence was greater for early-onset dementia. Only a small proportion of the socioeconomic inequity in dementia risk was mediated by healthy lifestyles, which indicates that measures other than healthy lifestyle promotion to improve social determinants of health are warranted. FUNDING The National Key Research and Development Program of China, the National Natural Science Foundation of China, the Hubei Province Science Fund for Distinguished Young Scholars, and the Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Rui Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruyi Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinchi Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junxiang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sen Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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18
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Pan L, Gao B, Zhu J, Guo J. Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults. JAMA Netw Open 2023; 6:e2349258. [PMID: 38147330 PMCID: PMC10751595 DOI: 10.1001/jamanetworkopen.2023.49258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Importance As a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined. Objective To investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults. Design, Setting, and Participants The Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest. Exposures Wealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth. Main Outcomes and Measures Cognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment. Results Among 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, -0.014 [95% CI, -0.027 to -0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P < .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P < .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P < .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older. Conclusions and Relevance In this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.
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Affiliation(s)
- Liulu Pan
- Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Gao
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junpeng Zhu
- Center for Rehabilitation Medicine, Department of Psychiatry, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jing Guo
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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LoBue C, Schaffert J, Dams-O'Connor K, Taiwo Z, Sander A, Venkatesan UM, O'Neil-Pirozzi TM, Hammond FM, Wilmoth K, Ding K, Bell K, Munro Cullum C. Identification of Factors in Moderate-Severe TBI Related to a Functional Decline in Cognition Decades After Injury. Arch Phys Med Rehabil 2023; 104:1865-1871. [PMID: 37160187 DOI: 10.1016/j.apmr.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To investigate whether a functional decline in cognitive activities decades after moderate-to-severe traumatic brain injury (m-sTBI) might relate to injury features and/or lifetime health factors, some of which may emerge as consequences of the injury. DESIGN Secondary analysis of the TBI Model Systems National Database, a prospective, multi-center, longitudinal study of patients with m-sTBI. SETTING TBI Model Systems Centers. PARTICIPANTS Included were 732 participants rated on the cognitive subscale of the Functional Independence Measure (FIM Cognitive), a metric for everyday cognitive skills, across 3 time points out to 20 years (visits at 2-, 10-, and 20-year follow-ups; N=732). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) FIM Cognitive Scale. Injury characteristics such as timing and features pertaining to severity and health-related factors (eg, alcohol use, socioeconomic status) were examined to discriminate stable from declining participants on the FIM Cognitive Scale using logistic regression. RESULTS At 20 years post-injury, there was a low base rate of FIM Cognitive decline (11%, n=78), with most being stable or having meaningful improvement (89%, n=654). Older age at injury, longer duration of post-traumatic amnesia, and presence of repetitive seizures were significant predictors of FIM Cognitive decline in the final model (area under the curve=0.75), while multiple health-related factors that can represent independent co-morbidities or possible consequences of injury were not. CONCLUSION(S) The strongest contributors to reported functional decline in cognitive activities later-in-life were related to acute characteristics of m-sTBI and experiencing post-traumatic seizures. Future studies are needed integrating functional with performance-based cognitive assessments to affirm conclusions and identify the timeline and trajectory of cognitive decline.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zinat Taiwo
- H. Bean Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
| | - Angelle Sander
- H. Bean Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
| | - Umesh M Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, PA; Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN
| | - Kristin Wilmoth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX; Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
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20
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Corney KB, Pasco JA, Stuart AL, Kavanagh BE, Mohebbi M, Sui SX, Williams LJ. Social determinants of health and cognitive function: A cross-sectional study among men without dementia. Brain Behav 2023; 13:e3235. [PMID: 37652752 PMCID: PMC10636419 DOI: 10.1002/brb3.3235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Certain age-related and medical factors have been associated with cognitive dysfunction; however, less is known regarding social determinants of health. The current study aimed to investigate associations between social determinants of health and cognitive function in a population-based sample of men without dementia. METHODS Data were drawn from the ongoing Geelong Osteoporosis Study (n = 536). Cognitive function was determined using the Cog-State Brief Battery. Area-based socioeconomic status (SES) was determined using the Index of Relative Socioeconomic Advantage and Disadvantage, marital status by self-report, and social support by the Multidimensional Scale of Perceived Social Support, which considers family, friends, and significant others. RESULTS Belonging to a higher SES group, being in a relationship (married/de-facto) and perceived social support from a significant other and friends were each associated with better overall cognitive function. In regard to the specific cognitive domains, higher SES was associated with better psychomotor function and visual learning, being in a relationship was associated with better working memory, and perceived social support from a significant other was associated with better attention and working memory, with perceived social support from friends associated with better psychomotor function. There were no associations detected between social support from family and any of the cognitive domains. CONCLUSION Higher SES, being in a relationship, and greater perceived social support from a significant other and friends were associated with better cognitive function. Further studies identifying underlying mechanisms linking social factors with cognition are needed to establish prevention strategies and enhance cognitive health.
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Affiliation(s)
- Kayla B. Corney
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Julie A. Pasco
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Barwon HealthUniversity Hospital GeelongGeelongAustralia
- Department of Medicine‐Western HealthThe University of MelbourneSt AlbansAustralia
| | - Amanda L. Stuart
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Bianca E. Kavanagh
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Deakin Rural Health, School of MedicineDeakin UniversityWarrnamboolAustralia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Faculty of Health, Biostatistics UnitDeakin UniversityGeelongAustralia
| | - Sophia X. Sui
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Lana J. Williams
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Barwon HealthUniversity Hospital GeelongGeelongAustralia
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21
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Dark HE, Huang A, Cordon J, Deal JA, Palta P, Windham BG, Barnes LL, Kucharska-Newton A, Mosley T, Gottesman RF, Sims M, Griswold M, Rentería MA, Manly JJ, Walker KA. The association of perceived discrimination with dementia risk in Black older adults. Alzheimers Dement 2023; 19:4346-4356. [PMID: 37218405 PMCID: PMC10734390 DOI: 10.1002/alz.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Non-Hispanic Black, compared to non-Hispanic White, older adults are at increased risk for dementia. This may be due partly to greater exposure to psychosocial stressors, such as discrimination; however, few studies have examined this association. METHODS We examined the association of perceived discrimination (e.g., everyday, lifetime, and discrimination burden) with dementia risk in 1583 Black adults co-enrolled in the Atherosclerosis Risk in Communities (ARIC) Study and the Jackson Heart Study (JHS). Perceived discrimination (defined continuously and using tertiles) was assessed at JHS Exam 1 (2000-2004; mean age ± SD:66.2 ± 5.5) and related to dementia risk through ARIC visit 6 (2017) using covariate-adjusted Cox proportional hazards models. RESULTS Associations of perceived everyday, lifetime, and burden of discrimination with dementia risk were not supported in age-adjusted models or demographic- and cardiovascular health-adjusted models. Results were similar across sex, income, and education. DISCUSSION In this sample, associations between perceived discrimination and dementia risk were not supported. HIGHLIGHTS In Black older adults perceived discrimination not associated with dementia risk. Younger age and greater education linked to greater perceived discrimination. Older age and less education among factors associated with dementia risk. Factors increasing exposure to discrimination (education) are also neuroprotective.
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Affiliation(s)
- Heather E. Dark
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Jenifer Cordon
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
| | - Jennifer A. Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, 10032, USA
| | - B. Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lisa L. Barnes
- Department of Neurological Sciences at Rush University Medical Center, Chicago, IL, 60612, USA
- Rush Alzheimer’s Disease Center at Rush University Medical Center, Chicago, IL, 60612, USA
| | - Anna Kucharska-Newton
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Program, NIH, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Michael Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, 21224
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Dukelow T, Vassilev P, Lawrence EG, Jacobson L, Koychev I, Muhammed K, Kennelly SP. Barriers to brain health behaviours: results from the Five Lives Brain Health Ireland Survey. Front Psychol 2023; 14:1101514. [PMID: 37691817 PMCID: PMC10483831 DOI: 10.3389/fpsyg.2023.1101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/17/2023] [Indexed: 09/12/2023] Open
Abstract
Modifiable risk factors for dementia remain prevalent in Ireland. A detailed examination of barriers to risk reduction behaviours in an Irish context has heretofore been lacking. Many existing studies examining barriers to brain health behaviours fail to examine how they might vary across different modifiable risk factors. This study undertook a detailed assessment of barriers to individual risk reduction behaviours. As existing research suggests that barriers may vary across sociodemographic factors, we sought to investigate the distribution of barriers across age, gender, educational status, and household income. The Five Lives Brain Health Ireland Survey is a cross-sectional survey that was distributed online amongst a non-patient population. The survey captured the following: (1) Sociodemographic factors; (2) Barriers to brain health behaviours; (3) Exposure to, and knowledge of, modifiable risk factors for dementia, namely diet, social interaction, exercise, hypertension, sleep, current low mood/depression, current smoking, alcohol consumption, cognitive stimulation, hearing impairment, diabetes, air pollution, and head injury; (4) Participants' perceptions regarding potential for dementia prevention, and risk reduction. Lack of motivation was the most prevalent barrier to consuming a healthy diet (64%, n = 213), physical activity (77.7%, n = 167), smoking cessation (68%, n = 85), and moderation of alcohol intake (56.3%, n = 67). Practical factors were the most prevalent barriers to addressing low mood (56.5%, n = 87), air pollution (30.1%, n = 58), hearing impairment (63.8%, n = 44), diabetes (11.1%, n = 5), and head injury (80%, n = 8). Emotional factors were the most prevalent barriers to engaging in mentally stimulating activity (56.9%, n = 66), social activity (54.9%, n = 302), and good sleep (70.1%, n = 129). Lack of knowledge was the most prevalent barrier to hypertension control (14.4%, n = 29). Distribution of barriers varied across age, gender, educational status, and household income. This study investigated barriers to lifestyle change to improve brain health in an Irish sample of adults aged 50 and above. Detailed subtyping of barriers, as well as examination of differences according to age, gender, education, and income were undertaken. The heterogeneity of barriers to brain health behaviours revealed in this study highlights the necessity to tailor public health interventions to their target population, taking into account the gender, age, educational status, and income of recipients.
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Affiliation(s)
- Tim Dukelow
- Cork University Hospital (CUH), Cork, Ireland
| | | | - Erin Grace Lawrence
- Five Lives SAS, Tours, France
- Unit of Psychological Medicine, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | | | - Ivan Koychev
- Five Lives SAS, Tours, France
- Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, England, United Kingdom
| | - Sean P. Kennelly
- Department of Age Related Health Care, Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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23
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Shao Q, Li Y, Lin L, Boardman M, Hamadi H, Zhao M. Demoralization syndrome and its impact factors among cancer patients in China. J Psychosoc Oncol 2023; 42:365-380. [PMID: 37609842 DOI: 10.1080/07347332.2023.2249895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE This study aimed to investigate the status of demoralization syndrome among cancer patients and explore the key factors influencing demoralization syndrome. METHOD Cross-sectional study design of cancer patients in Xiamen, China. Patients completed the Mandarin version of the Perceived Social Support Scale, Patient-Reported Outcome Measures, The Anderson Symptom Inventory, and the Demoralization Scale. FINDINGS 187/199 (94%) of patients completed questionnaires. This study found that almost half of the cancer patients in Xiamen, China experience moderate to high levels of demoralization syndrome. Furthermore, the findings indicated that the family residence (Large Urban: b = 2.73, p = 0.02), average monthly income (b=-3.05, p = 0.03), source of income, religiousness (b = 1.37, p = 0.04) and financial toxicity (b = 3.3, p < 0.001), and social support (b = 1.02; p < 0.001) are the influencing factors of cancer patients' demoralization syndrome. CONCLUSION These findings emphasize the importance of addressing psychological distress and providing adequate social and financial support for cancer patients to maintain their morale and overall well-being.
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Affiliation(s)
- Qiuzhi Shao
- Affiliated Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yiming Li
- Xiamen Medical College, Xiamen, Fujian, China
| | - Liyu Lin
- Affiliated Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Megan Boardman
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida, Jacksonville, Florida, USA
| | - Hanadi Hamadi
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida, Jacksonville, Florida, USA
| | - Mei Zhao
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida, Jacksonville, Florida, USA
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Testa A, Jackson DB, Kaufmann C, Spira AP, Thorpe RJ. Mass incarceration and cognitive impairment in older adults: Setting a research agenda. J Am Geriatr Soc 2023; 71:2680-2684. [PMID: 37052187 PMCID: PMC10524200 DOI: 10.1111/jgs.18355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/10/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Kaufmann
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Roland J. Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Becerril A, Pfoh ER, Hashmi AZ, Mourany L, Gunzler DD, Berg KA, Krieger NI, Krishnan K, Moore SE, Kahana E, Dawson NV, Luezas Shamakian L, Campbell JW, Perzynski AT, Dalton JE. Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study. J Am Geriatr Soc 2023; 71:2406-2418. [PMID: 36928611 DOI: 10.1111/jgs.18322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. METHODS In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. RESULTS Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. CONCLUSION Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.
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Affiliation(s)
- Alissa Becerril
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Pfoh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ardeshir Z Hashmi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lyla Mourany
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kristen A Berg
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Nikolas I Krieger
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eva Kahana
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Neal V Dawson
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Adam T Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Jarrod E Dalton
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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26
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Nong W, Mo G, Luo C. Exploring the bidirectional causal link between household income status and genetic susceptibility to neurological diseases: findings from a Mendelian randomization study. Front Public Health 2023; 11:1202747. [PMID: 37564429 PMCID: PMC10411908 DOI: 10.3389/fpubh.2023.1202747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives Observational studies have revealed that socioeconomic status is associated with neurological disorders and aging. However, the potential causal effect between the two remains unclear. We therefore aimed to investigate the causal relationship between household income status and genetic susceptibility to neurological diseases using a bidirectional Mendelian randomization (MR) study. Methods An MR study was conducted on a large-sample cohort of the European population pulled from a publicly available genome-wide association study dataset, using a random-effects inverse-variance weighting model as the main standard. MR-Egger regression, weighted median, and maximum likelihood estimation were also performed concurrently as supplements. A sensitivity analysis, consisting of a heterogeneity test and horizontal pleiotropy test, was performed using Cochran's Q, MR-Egger intercept, and MR-PRESSO tests to ensure the reliability of the conclusion. Results The results suggested that higher household income tended to lower the risk of genetic susceptibility to Alzheimer's disease (odds ratio [OR]: 0.740, 95% confidence interval [CI] = 0.559-0.980, p-value = 0.036) and ischemic stroke (OR: 0.801, 95% CI = 0.662-0.968, p-value = 0.022). By contrast, higher household income tended to increase the risk of genetic susceptibility to Parkinson's disease (OR: 2.605, 95% CI = 1.413-4.802, p-value = 0.002). No associations were evident for intracranial hemorrhage (OR: 1.002, 95% CI = 0.607-1.653, p-value = 0.993), cerebral aneurysm (OR: 0.597, 95% CI = 0.243-1.465, p-value = 0.260), subarachnoid hemorrhage (OR: 1.474, 95% CI = 0.699-3.110, p-value = 0.308), or epilepsy (OR: 1.029, 95% CI = 0.662-1.600, p-value = 0.899). The reverse MR study suggested no reverse causal relationship between neurological disorders and household income status. A sensitivity analysis verified the reliability of the results. Conclusion Our results revealed that the populations with a superior household income exhibit an increased predisposition of genetic susceptibility to Parkinson's Disease, while demonstrating a potential decreased genetic susceptibility to ischemic stroke and Alzheimer's disease.
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Affiliation(s)
| | | | - Chun Luo
- Department of Neurology, Affiliated Minzu Hospital of Guangxi Medical University, Nanning, China
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Watson J, Green MA, Giebel C, Darlington-Pollock F, Akpan A. Social and spatial inequalities in healthcare use among people living with dementia in England (2002-2016). Aging Ment Health 2023; 27:1476-1487. [PMID: 35959941 PMCID: PMC9612936 DOI: 10.1080/13607863.2022.2107176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Healthcare services for people living with dementia (PLWD) are stretched, and government promises of increased funding remain undelivered. With the UK dementia population to surpass 1 million by 2024, and dementia care costs predicted to almost treble by 2040, it is essential we understand differences in healthcare use among PLWD. This study aimed to explore social and spatial variations in healthcare use among people diagnosed with dementia (2002-2016). METHODS Data were derived from Electronic Health Records of Clinical Practice Research Datalink GP patients in England (n = 142,302). To standardise healthcare contacts, rates of healthcare contacts per year were calculated for three primary (GP observations and medications) and three secondary healthcare types [Accident & Emergency (A&E) attendances and, emergency and elective hospital admissions]. Fully-adjusted generalised linear regression models were used to identify healthcare use variation by social and spatial groups. Twelve models were generated, one for each healthcare type in early- and late-onset populations separately. RESULTS This study highlights numerous social and spatial variations in healthcare use among PLWD. Among PLWD, several groups tended to have healthcare service use more closely associated with negative outcomes, including a greater likelihood of A&E attendances and emergency and elective hospital admissions. These groups include: men, people from White ethnicity groups and people from more deprived and rural areas. CONCLUSIONS Systemic and social measures are needed to reduce variations in healthcare use inequalities in PWLD. These include greater healthcare continuity, health checks and medicines reviews, culturally appropriate services, better and more accessible treatment and improved infrastructure.
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Affiliation(s)
- James Watson
- School of Environmental Sciences, The University of Liverpool, Liverpool, United Kingdom
| | - Mark A. Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, United Kingdom
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
- NIHR ARC NWC, Liverpool, United Kingdom
| | | | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
- Healthy Ageing Group, University of Cumbria, Cumbria, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- NIHR CRN NWC, Liverpool, United Kingdom
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28
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Li F, Liu W, Hu C, Tang M, Zhang Y, Ho HC, Peng S, Li Z, Wang Q, Li X, Xu B, Li F. Global association of greenness exposure with risk of nervous system disease: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 877:162773. [PMID: 36933739 DOI: 10.1016/j.scitotenv.2023.162773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 05/06/2023]
Abstract
Nervous system disease (NSD) is a global health burden with increasing prevalence in the last 30 years. There is evidence that greenness can improve nervous system health through a variety of mechanisms; however, the evidence is inconsistent. In the present systematic review and meta-analysis, we examined the relationship between greenness exposure and NSD outcomes. Studies on the relationship between greenness and NSD health outcomes published till July 2022 were searched in PubMed, Cochrane, Embase, Scopus, and Web of Science. In addition, we searched the cited literature and updated our search on Jan 20, 2023, to identify any new studies. We included human epidemiological studies that assess the association of greenness exposure with the risk of NSD. Greenness exposure was measured using NDVI (the normalized difference vegetation index) and the outcome was the mortality or morbidity of NSD. The pooled relative risks (RRs) were estimated using a random effects model. Of 2059 identified studies, 15 studies were included in our quantitative evaluation, in which 11 studies found a significant inverse relationship between the risk of NSD mortality or incidence/prevalence and an increase in surrounding greenness. The pooled RRs for cerebrovascular diseases (CBVD), neurodegenerative diseases (ND), and stroke mortality were 0.98 (95 % CI: 0.97, 1.00), 0.98 (95 % CI: 0.98, 0.99), and 0.96 (95 % CI: 0.93, 1.00), respectively. The pooled RRs for PD incidence and stroke prevalence/incidence were 0.89 (95 % CI: 0.78, 1.02) and 0.98 (95 % CI: 0.97, 0.99), respectively. The confidence of evidence for ND mortality, stroke mortality, and stroke prevalence/incidence was downgraded to "low", while CBVD mortality and PD incidence were downgraded to "very low" due to inconsistency. We found no evidence of publication bias and the sensitivity analysis results of all subgroups are robust except for the stroke mortality subgroup. This is the first comprehensive meta-analysis of greenness exposure and NSD outcomes in which an inverse relationship was observed. It is necessary to conduct further research to ascertain the role greenness exposure plays in various NSDs and the management of greenness should be considered a public health strategy.
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Affiliation(s)
- Fangzheng Li
- School of Landscape Architecture, Beijing Forestry University, Beijing 100083, China.
| | - Wei Liu
- School of Art, Qufu Normal University, Rizhao 276826, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Mingcheng Tang
- School of Landscape Architecture and Forestry, Qingdao Agricultural University, Qingdao 266109, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Hung Chak Ho
- Department of Anaesthesiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shijia Peng
- Charles Davis's Lab Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Zhouyuan Li
- School of Grassland Science, Beijing Forestry University, Beijing 100083, China
| | - Qing Wang
- China CDC Key Laboratory of Environment and Population Health/National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiong Li
- School of Landscape Architecture, Beijing Forestry University, Beijing 100083, China
| | - Bing Xu
- Department of Earth System Science, Tsinghua University, 10084 Beijing, China
| | - Fengyi Li
- School of Landscape Architecture and Forestry, Qingdao Agricultural University, Qingdao 266109, China.
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Mullin DS, Stirland LE, Russ TC, Luciano M, Muniz-Terrera G. Socioeconomic status as a risk factor for motoric cognitive risk syndrome in a community-dwelling population: A longitudinal observational study. Eur J Neurol 2023; 30:1191-1199. [PMID: 36755198 DOI: 10.1111/ene.15731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Motoric cognitive risk (MCR) is a syndrome characterised by measured slow gait speed and self-reported cognitive complaints. MCR is a high-risk state for adverse health outcomes in older adults, particularly cognitive impairment and dementia. Previous studies have identified risk factors for MCR, but the effect of socioeconomic status has, to date, been insufficiently examined. This study explored the association between MCR and socioeconomic status, as determined by occupational social class and years of education. METHODS Some 692 community-based adults of the Lothian Birth Cohort 1936 (LBC1936), aged 70 years at baseline, were followed up after 6 years and classified into non-MCR and MCR groups. We applied logistic regression analyses adjusting for demographic, lifestyle, and health covariates to investigate the association between MCR and years of education and occupational social class, categorised into manual versus non-manual occupations. RESULTS MCR prevalence at age 76 years was 5.6% (95% CI 4.0-7.6). After multivariate adjustment, participants of lower socioeconomic status (manual occupation) had a greater than three-fold increased likelihood of MCR (adjusted odds ratio 3.55, 95% CI 1.46-8.74; p = 0.005) compared with those of higher socioeconomic status (non-manual occupation). CONCLUSIONS Working in a manual job earlier in life triples the risk of MCR later in life, regardless of education. Unravelling this association will likely reveal important pathophysiological mechanisms underlying MCR and may unearth modifiable risk factors which could be targeted to reduce the incidence of MCR and, ultimately, dementia. Policy and healthcare practice addressing dementia risks such as MCR in their social context and early in the lifecourse could be effective strategies for reducing health inequalities in older age.
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Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Lucy E Stirland
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Michelle Luciano
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK
- Department of Social Medicine, Ohio University, Athens, Ohio, USA
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30
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Hansra GK, Lim H, Cheong CY, Yap P. Knowledge and Attitudes towards Dementia among the General Public in Singapore: A Comparative Analysis. Dement Geriatr Cogn Disord 2023; 52:214-221. [PMID: 37080177 DOI: 10.1159/000530271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/15/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION This paper provides a summary of findings on the public's knowledge and attitudes towards dementia. We aim to investigate if the attitudes of Singaporeans towards dementia have changed over the years by adopting a questionnaire used in a similar study in 2012. METHODS A cross-sectional, descriptive study was conducted through the dissemination of an existing, online questionnaire to participants above 16 years of age. Out of 1,500 subjects, results from 1,373 participants were analysed. Descriptive statistics were used to analyse and compare results from the 2012 study while a latent class analysis was performed to understand the categories of study participants based on varying levels of attitudes, knowledge and stigma. RESULTS The mean age of study participants was 43.8 (SD = 15.7). Majority of the participants were females (76.5%), between 51 and 60 years of age (29.6%) and belonged to the Chinese ethnic group (77.8%). Results demonstrated that there were significant differences in attitudes towards dementia between 2012 and 2021. There was a 70.2% improvement in stigma-associated attitudes and an increase in correct responses to 4 out of 5 questions in the knowledge section. CONCLUSION Findings of this study suggest that the general public has a better knowledge and more positive attitude towards dementia. This could have been attributed to higher literacy levels of the current study population and effectiveness of established outreach initiatives in Singapore. However, further research with a more balanced representation of ethnic and cultural groups would offer more comprehensive insights into dementia health literacy.
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Affiliation(s)
- Gurpreet Kaur Hansra
- School of Health Sciences, Ngee Ann Polytechnic, Singapore, Singapore
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Hazel Lim
- School of Health Sciences, Ngee Ann Polytechnic, Singapore, Singapore
| | - Chin Yee Cheong
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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Lai KY, Webster C, Kumari S, Gallacher JEJ, Sarkar C. The associations of socioeconomic status with incident dementia and Alzheimer's disease are modified by leucocyte telomere length: a population-based cohort study. Sci Rep 2023; 13:6163. [PMID: 37061546 PMCID: PMC10105714 DOI: 10.1038/s41598-023-32974-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/05/2023] [Indexed: 04/17/2023] Open
Abstract
Socio-economic status (SES) and biological aging are risk factors for dementia, including Alzheimer's disease, however, it is less clear if the associations with SES vary sufficiently across different biological age strata. We used data from 331,066 UK Biobank participants aged 38-73 with mean follow-up of 12 years to examine if associations between SES (assessed by educational attainment, employment status and household income) and dementia and Alzheimer's disease are modified by biological age (assessed by leucocyte telomere length: LTL). Diagnosis of events was ascertained through hospital admissions data. Cox regressions were used to estimate hazard ratios [HRs]. A consistent dose-response relationship was found, with participants in low SES and shorter LTL strata (double-exposed group) reporting 3.28 (95% confidence interval [CI] 2.57-4.20) and 3.44 (95% CI 2.35-5.04) times higher risks of incident dementia and Alzheimer's disease respectively, compared to those of high SES and longer LTL (least-exposed group). Of interest is a synergistic interaction between SES and LTL to increase risk of dementia (RERI 0.57, 95% CI 0.07-1.06) and Alzheimer's disease (RERI 0.79, 95% CI 0.02-1.56). Our findings that SES and biological age (LTL) are synergistic risk factors of dementia and Alzheimer's disease may suggest the need to target interventions among vulnerable sub-groups.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
| | - Sarika Kumari
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
| | - John E J Gallacher
- Dementias Platform UK, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
- Department of Urban Planning and Design, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
- Dementias Platform UK, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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Hovsepian VE, Sadak T, Schlak AE, Liu J, Poghosyan L. The Association between Primary Care Practices' Structural Capabilities and Hospitalizations among Persons Living with Dementia. J Appl Gerontol 2023:7334648231155444. [PMID: 36738162 DOI: 10.1177/07334648231155444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Persons living with dementia (PLWD) are more likely to be hospitalized than individuals without dementia. Little is known about key features (i.e., structural capabilities) in primary care practices where PLWD receive care. This study assessed the relationship between structural capabilities (i.e., care coordination, community integration, and reminder systems) and hospitalizations among PLWD. Methods: We conducted a secondary analysis of cross-sectional data from 5001 PLWD in 192 practices and used three datasets: nurse practitioner surveys, Medicare claims, and Minimum Data Set. Using generalized estimating equations, we evaluated the association between structural capabilities and hospitalizations. Results: PLWD who received care from practices with care coordination were less likely to have hospitalizations (OR = 0.62, p < .05). No statistically significant associations were observed between community integration and reminder systems and hospitalizations. Conclusion: Primary care practices need to tailor structural capabilities to address the needs of PLWD to reduce hospitalizations.
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Affiliation(s)
- Vaneh E Hovsepian
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Tatiana Sadak
- 7284University of Washington, WA School of Nursing, Seattle, WA, USA
| | | | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
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Gregory S, Pullen H, Ritchie CW, Shannon OM, Stevenson EJ, Muniz-Terrera G. Mediterranean diet and structural neuroimaging biomarkers of Alzheimer's and cerebrovascular disease: A systematic review. Exp Gerontol 2023; 172:112065. [PMID: 36529364 DOI: 10.1016/j.exger.2022.112065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Previous studies have demonstrated an association between adherence to the Mediterranean diet (MedDiet) and better cognitive performance, lower incidence of dementia and lower Alzheimer's disease biomarker burden. The aim of this systematic review was to evaluate the evidence base for MedDiet associations with hippocampal volume and white matter hyperintensity volume (WMHV). We searched systematically for studies reporting on MedDiet and hippocampal volume or WMHV in MedLine, EMBASE, CINAHL and PsycInfo. Searches were initially carried out on 21st July 2021 with final searches run on 23rd November 2022. Risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of an initial 112 papers identified, seven papers were eligible for inclusion in the review reporting on 21,933 participants. Four studies reported on hippocampal volume, with inconclusive or no associations seen with MedDiet adherence. Two studies found a significant association between higher MedDiet adherence and lower WMHV, while two other studies found no significant associations. Overall these results highlight a gap in our knowledge about the associations between the MedDiet and AD and cerebrovascular related structural neuroimaging findings.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Hannah Pullen
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Brain Health Scotland, UK.
| | - Oliver M Shannon
- Faculty of Medical Sciences, Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
| | - Emma J Stevenson
- Faculty of Medical Sciences, Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK.
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Social Medicine, Ohio University, OH, USA.
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Liu SZ, Tahmasebi G, Sheng Y, Dinov ID, Tsilimingras D, Liu X. Sex difference in the associations of socioeconomic status, cognitive function and brain volume with dementia in old adults: Findings from the OASIS study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.05.23284240. [PMID: 36711777 PMCID: PMC9882555 DOI: 10.1101/2023.01.05.23284240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Sex differences in the association of cognitive function and imaging measures with dementia have not been fully investigated while sex-based investigation of dementia has been discussed. Understanding sex differences in the dementia-related socioeconomic, cognitive, and imaging measurements is important for uncovering sex-related pathways to dementia and facilitating early diagnosis, family planning, and cost control. Methods We selected data from the Open Access Series of Imaging Studies with longitudinal measurements of brain volumes on 150 individuals aged 60 to 96 years. Dementia status was determined using the Clinical Dementia Rating (CDR) scale, and Alzheimer's disease was diagnosed as a CDR of ≥ 0.5. Generalized estimating equation models were used to estimate the associations of socioeconomic, cognitive and imaging factors with dementia in men and women. Results Lower education affected dementia more in women than in men. Age, education, Mini-Mental State Examination (MMSE), and normalized whole-brain volume (nWBV) were associated with dementia in women whereas only MMSE and nWBV were associated with dementia in men. Lower socioeconomic status was associated with a reduced estimated total intracranial volume in men, but not in women. Ageing and lower MMSE scores were associated with reduced nWBV in both men and women. Conclusions The association between education and prevalence of dementia differs in men and women. Women may have more risk factors for dementia than men.
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Brenowitz WD, Yaffe K. Observational studies in Alzheimer disease: bridging preclinical studies and clinical trials. Nat Rev Neurol 2022; 18:747-757. [PMID: 36316487 PMCID: PMC9894623 DOI: 10.1038/s41582-022-00733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Abstract
Recent high-profile failures of Alzheimer disease treatments at the clinical trial stage have led to renewed efforts to identify and test novel interventions for Alzheimer disease and related dementias (ADRD). In this Perspective, we highlight the importance of including well-designed observational studies as part of these efforts. Observational research is an important cornerstone for gathering evidence on risk factors and causes of ADRD; this evidence can then be combined with data from preclinical studies and randomized controlled trials to inform the development of effective interventions. Observational study designs can be particularly beneficial for hypothesis generation, posing questions that are unethical or impractical for a trial setting, studying life-course associations, research in populations typically not included in trials, and public health surveillance. Here, we discuss each of these situations in the specific context of ADRD research. We also highlight novel approaches to enhance causal inference and provide a timely discussion on how observational epidemiological studies help provide a bridge between preclinical studies and successful interventions for ADRD.
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Affiliation(s)
- Willa D Brenowitz
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
- San Francisco VA Medical Center, San Francisco, CA, USA.
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Ding E, Wang Y, Liu J, Tang S, Shi X. A review on the application of the exposome paradigm to unveil the environmental determinants of age-related diseases. Hum Genomics 2022; 16:54. [DOI: 10.1186/s40246-022-00428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractAge-related diseases account for almost half of all diseases among adults worldwide, and their incidence is substantially affected by the exposome, which is the sum of all exogenous and endogenous environmental exposures and the human body’s response to these exposures throughout the entire lifespan. Herein, we perform a comprehensive review of the epidemiological literature to determine the key elements of the exposome that affect the development of age-related diseases and the roles of aging hallmarks in this process. We find that most exposure assessments in previous aging studies have used a reductionist approach, whereby the effect of only a single environmental factor or a specific class of environmental factors on the development of age-related diseases has been examined. As such, there is a lack of a holistic and unbiased understanding of the effect of multiple environmental factors on the development of age-related diseases. To address this, we propose several research strategies based on an exposomic framework that could advance our understanding—in particular, from a mechanistic perspective—of how environmental factors affect the development of age-related diseases. We discuss the statistical methods and other methods that have been used in exposome-wide association studies, with a particular focus on multiomics technologies. We also address future challenges and opportunities in the realm of multidisciplinary approaches and genome–exposome epidemiology. Furthermore, we provide perspectives on precise public health services for vulnerable populations, public communications, the integration of risk exposure information, and the bench-to-bedside translation of research on age-related diseases.
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Mullin DS, Stirland LE, Welstead M, Russ TC, Luciano M, Muniz‐Terrera G. Prevalence and predictors of Motoric Cognitive Risk syndrome in a community-dwelling older Scottish population: A longitudinal observational study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5824. [PMID: 36200618 PMCID: PMC9828770 DOI: 10.1002/gps.5824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Motoric Cognitive Risk (MCR) is a gait-based predementia syndrome that is easy to measure and prognostic of dementia and falls. We aimed to examine the prevalence and risk factors for MCR, and assess its overlap with Mild Cognitive Impairment, Prefrailty, and Frailty, in a cohort of older Scottish adults without dementia. METHODS In this longitudinal prospective study, we classified 690 participants (mean [SD] age 76.3 [0.8] years; wave 3) of the Lothian Birth Cohort 1936 (LBC1936) into non-MCR or MCR groups. We examined their baseline (age 69.5 [0.8] years; wave 1) risk factors for MCR at waves 3, 4, and 5 (6, 9, and 12 years later respectively). RESULTS MCR prevalence rate ranged from 5.3% to 5.7% across the three waves. The presence of MCR was associated with older baseline age (6 and 9 years later), lower occupational socioeconomic status (6 years later), and worse scores in a range of tests of executive function (6, 9 and 12 years later). Approximately 46% of the MCR group also had Mild Cognitive Impairment, and almost everyone in the MCR group had either Prefrailty or Frailty. CONCLUSIONS The prevalence of MCR in this Scottish cohort is lower than the pooled global average, possibly reflecting the general good health of the LBC cohort. However, it is higher than the prevalence in two neighbouring countries' cohorts, which may reflect the younger average ages of those cohorts. Future LBC1936 research should assess the risk factors associated with MCR to validate previous findings and analyse novel predictive factors, particularly socioeconomic status.
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Affiliation(s)
- Donncha S. Mullin
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Lucy E. Stirland
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Miles Welstead
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Michelle Luciano
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Department of Social MedicineOhio UniversityAthensOhioUSA
- BrainLatUniversidad Adolfo IbanezPenalolenChile
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Wang ZQ, Fei L, Xu YM, Deng F, Zhong BL. Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey. Front Public Health 2022; 10:1032118. [PMID: 36267996 PMCID: PMC9577294 DOI: 10.3389/fpubh.2022.1032118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 01/29/2023] Open
Abstract
Background Integrating the management of dementia into primary healthcare is a cost-effective way to reduce the burden of dementia but the clinical epidemiology of dementia in primary healthcare settings remains unclear. This study investigated the prevalence and correlates of suspected dementia in Chinese older adults receiving primary healthcare. Methods In this multicenter cross-sectional survey, a total of 773 older adults (≥65 years) were consecutively recruited from seven urban and six rural primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the Brief Community Screening Instrument for Dementia (BCSI-D). Participants with suspected dementia were those who were screened positive on the BCSI-D. Results The prevalence of suspected dementia in older primary healthcare adults was 26.8%. Factors significantly associated with suspected dementia were female sex (OR = 1.95, P < 0.001), age-group of 75+ (OR = 1.68, P = 0.004), poor financial status (OR = 4.79, P < 0.001), rural residence (OR = 1.47, P = 0.032), no regular physical exercise (OR = 1.74, P = 0.002), and stroke and other cerebrovascular diseases (OR = 1.97, P = 0.015). Conclusions Chinese older adults receiving primary healthcare are at high risk of suspected dementia. Screening and intervention efforts for dementia in primary healthcare settings may be more useful to target older adults who are women, are 75 years and above, have poor economic status, are rural residents, have no exercise habit, and suffer from cerebrovascular diseases.
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Affiliation(s)
- Zong-Qin Wang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lei Fei
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Fang Deng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
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Saiyasit N, Butlig EAR, Chaney SD, Traylor MK, Hawley NA, Randall RB, Bobinger HV, Frizell CA, Trimm F, Crook ED, Lin M, Hill BD, Keller JL, Nelson AR. Neurovascular Dysfunction in Diverse Communities With Health Disparities-Contributions to Dementia and Alzheimer's Disease. Front Neurosci 2022; 16:915405. [PMID: 35844216 PMCID: PMC9279126 DOI: 10.3389/fnins.2022.915405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer's disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD.
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Affiliation(s)
- Napatsorn Saiyasit
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Evan-Angelo R. Butlig
- Department of Neurology, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Intellectual and Developmental Disabilities Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha D. Chaney
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Miranda K. Traylor
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Nanako A. Hawley
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Ryleigh B. Randall
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Hanna V. Bobinger
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Carl A. Frizell
- Department of Physician Assistant Studies, University of South Alabama, Mobile, AL, United States
| | - Franklin Trimm
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Errol D. Crook
- Department of Internal Medicine, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Mike Lin
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Joshua L. Keller
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Amy R. Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
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Dong C, Zhou C, Fu C, Hao W, Ozaki A, Shrestha N, Virani SS, Mishra SR, Zhu D. Sex differences in the association between cardiovascular diseases and dementia subtypes: a prospective analysis of 464,616 UK Biobank participants. Biol Sex Differ 2022; 13:21. [PMID: 35526028 PMCID: PMC9080133 DOI: 10.1186/s13293-022-00431-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Whether the association of cardiovascular diseases (CVDs) with dementia differs by sex remains unclear, and the role of socioeconomic, lifestyle, genetic, and medical factors in their association is unknown. METHODS We used data from the UK Biobank, a population-based cohort study of 502,649 individuals. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between CVD (coronary heart diseases (CHD), stroke, and heart failure) and incident dementia (all-cause dementia, Alzheimer's Disease (AD), and vascular dementia (VD)). The moderator roles of socioeconomic (education, income), lifestyle (smoking, BMI, leisure activities, and physical activity), genetic factors (APOE allele status), and medical history were also analyzed. RESULTS Compared to people who did not experience a CVD event, the HRs (95%CI) between CVD and all-cause dementia were higher in women compared to men, with an RHR (Female/Male) of 1.20 (1.13, 1.28). Specifically, the HRs for AD were higher in women with CHD and heart failure compared to men, with an RHR (95%CI) of 1.63 (1.39, 1.91) and 1.32 (1.07, 1.62) respectively. The HRs for VD were higher in men with heart failure than women, with RHR (95%CI) of 0.73 (0.57, 0.93). An interaction effect was observed between socioeconomic, lifestyle, genetic factors, and medical history in the sex-specific association between CVD and dementia. CONCLUSION Women with CVD were 1.5 times more likely to experience AD than men, while had 15% lower risk of having VD than men.
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Affiliation(s)
- Caiyun Dong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Chunmiao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Chunying Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Wenting Hao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan.,Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan
| | - Nipun Shrestha
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Salim S Virani
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Shiva Raj Mishra
- Academy for Data Sciences and Global Health, Kathmandu, Nepal.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Dongshan Zhu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China. .,Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
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Suresh S, Begum RF, Singh S A, V C. Anthocyanin as a therapeutic in Alzheimer's disease: A systematic review of preclinical evidences. Ageing Res Rev 2022; 76:101595. [PMID: 35217244 DOI: 10.1016/j.arr.2022.101595] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this systematic review is to ponder the possible mechanism of action of anthocyanin in Alzheimer's disease (AD), to prompt the development of anthocyanin-based dietary supplementation or therapeutic intervention for AD and to explore the natural sources of anthocyanins. METHODS Electronic bibliographic databases such as PubMed, ScienceDirect, Proquest, DOAJ, Scopus, and Google Scholar were searched for preclinical studies probing the efficacy of anthocyanin on AD. The search strategy included no time limit, but was restricted to English. The review protocol is registered on PROSPERO, registration no. CRD42021272972. The systematic review followed the PICO approach for inclusion of reports. All the reports were appraised for risk of bias using the SYRCLE's RoB tool. RESULTS Bibliographic details of the article, animal strain/weight/age, induction model, anthocyanin source, type of anthocyanin, dose, route of administration, duration, and the outcome measures were extracted from 12 retrieved reports explicitly. The implication of food-based anthocyanin in acute and long-term cognition and Aβ mediated neurodegeneration appears alluring. Majority of the studies comprehended in this review had moderate methodological quality. DISCUSSION Efficacy of anthocyanin in alleviating oxidative stress, reactive astrogliosis, cholinergic dysfunction, apoptosis, synaptotoxicity, neuroinflammation, tau hyperphosphorylation, dysregulated membrane potential, neuronal extracellular calcium, dysfunctional amyloidogenic pathway, and cognitive deficits in various rodent models of AD is manifested compositely in 12 studies.
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Annual Incidence of Dementia from 2003 to 2018 in Metropolitan Seoul, Korea: A Population-Based Study. J Clin Med 2022; 11:jcm11030819. [PMID: 35160270 PMCID: PMC8836574 DOI: 10.3390/jcm11030819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/10/2022] Open
Abstract
National dementia plans were applied in dementia support centers established in Seoul, Korea between 2007 and 2009. However, the annual incidence rates of dementia in Seoul have not been reported. We investigated this annual incidence and the characteristics of incident cases from 2003 to 2018. The customized research database of the Korean National Health Insurance Services was used. The annual crude and age-standardized incidence of dementia patients and their characteristics were analyzed. This study analyzed 108,596 incident dementia cases aged ≥60 years. The incidence rate increased from 2003 to 2011, including a rapid increment from 2007 to 2011. From 2011 to 2018, the crude (age-standardized) incidence per 105 person-years decreased from 641.51 (577.12) to 448.26 (361.23). The proportion of incident dementia cases was highest in the highest income group every year. However, the proportion of incident dementia cases in the lowest income group increased from 10.4% in 2003 to 25.8% in 2011. The annual incidence rate of dementia showed a sharp increase immediately after 2007, the year dementia support centers began to be introduced, and then stabilized after 2011. The characteristics of incident dementia cases have changed, including the proportion in the low-income group.
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The 2018 Japan Floods Increased Prescriptions of Antidementia Drugs among Disaster Victims. J Am Med Dir Assoc 2022; 23:1045-1051. [DOI: 10.1016/j.jamda.2021.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/01/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022]
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Association between depression and the risk of Alzheimer's disease using the Korean National Health Insurance Service-Elderly Cohort. Sci Rep 2021; 11:22591. [PMID: 34799679 PMCID: PMC8604944 DOI: 10.1038/s41598-021-02201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022] Open
Abstract
In this cohort study, we assessed the association between depression and the risk of Alzheimer’s disease from data obtained from the 2002 to 2013 Korean National Health Insurance Service-Elderly Cohort Database, which accounts for 10% of the South Korean population aged > 60 years. A total 518,466 patients were included in the analysis and followed up, unless they were excluded due to death or migration. Patients who sought treatment for depression or dementia within 1 year of the washout period and who were diagnosed with dementia within the 1-year period of the diagnosis of depression were excluded from the study. The risk of dementia was analysed using Cox proportional hazards models. Patients with a history of depression during the follow-up period were at a higher risk of Alzheimer’s disease than those without a history of depression (HR 3.35, CI 3.27–3.42). The severe-depression group exhibited the highest risk of Alzheimer’s disease (HR 4.41, CI 4.04–4.81), while the mild-depression group exhibited a relatively lower risk of Alzheimer’s disease (HR 3.31, CI 3.16–3.47). The risk of Alzheimer’s disease was associated with depression history and an increased severity of depression increased the risk of Alzheimer’s disease.
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Lee CJ, Lee JY, Han K, Kim DH, Cho H, Kim KJ, Kang ES, Cha BS, Lee YH, Park S. Blood Pressure Levels and Risks of Dementia: a Nationwide Study of 4.5 Million People. Hypertension 2021; 79:218-229. [PMID: 34775786 DOI: 10.1161/hypertensionaha.121.17283] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There are inconsistent results on the impacts of controlling blood pressure (BP) on the risk of dementia. We investigated the association between BP and risk of dementia subtypes by antihypertensive treatment and comorbidities. Using the Korean National Health Insurance Service-Health Screening Database from 2009 to 2012, a total of 4 522 447 adults aged 60+ years without a history of dementia were analyzed and followed up for a mean of 5.4 years. Individuals were classified according to their baseline systolic BP (SBP) and diastolic BP; SBP 130 to <140 mm Hg and diastolic BP 80 to <90 mm Hg were used as reference groups. The risk of overall dementia and probable Alzheimer disease was significantly higher in the SBP≥160 and lower SBP groups. These U-shaped associations were consistent regardless of antihypertensive use or comorbidities. The risk of probable vascular dementia (VaD) was not higher among lower SBP groups and increased gradually as SBP increased. Although there was a linear association between SBP and the risk of probable VaD in individuals not taking antihypertensives or without comorbidities, there was a U-shaped association in individuals taking antihypertensives or with comorbidities. Patterns of association between diastolic BP and risk of probable Alzheimer disease or probable VaD were similar to those with SBP, except for the risk of probable VaD in individuals taking antihypertensives. In conclusion, risks of probable Alzheimer disease and probable VaD were different among lower BP groups. Although the risk of dementia appears higher in people with lower BP receiving antihypertensives, this finding may be affected by comorbidities.
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Affiliation(s)
- Chan Joo Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.H.)
| | - Da Hye Kim
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (D.H.K.)
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital (H.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Geriatrics (K.J.K.), Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism (J.-Y.L., E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Endocrine Research (E.S.K., B.-S.C., Y.-h.L.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
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Appel AM, Brønnum-Hansen H, Garde AH, Hansen ÅM, Ishtiak-Ahmed K, Islamoska S, Mortensen EL, Nabe-Nielsen K. Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study. J Aging Health 2021; 34:184-195. [PMID: 34388948 DOI: 10.1177/08982643211037200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. METHODS We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. RESULTS When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose-response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. DISCUSSION Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia.
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Affiliation(s)
- Andreas M Appel
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,Danish Dementia Research Centre, 53146Rigshospitalet, Copenhagen, Denmark
| | | | - Anne H Garde
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,2686The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark.,2686The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Depression and Anxiety, 1006Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, 1006Aarhus University, Aarhus, Denmark
| | - Sabrina Islamoska
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark
| | - Erik L Mortensen
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark
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Nandwana V, Kaur J, Singh R, Jaka S, Kaur G, Rawal E, Mathialagan K, Amuk Williams OC. Predictors of Hospitalization for Manic Episode in Alzheimer's Dementia: Inputs From an Inpatient Case-Control Study. Cureus 2021; 13:e17333. [PMID: 34567877 PMCID: PMC8451530 DOI: 10.7759/cureus.17333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives The correlates of manic episodes in dementia have not been systematically studied. The primary goal of our study is to compare the sociodemographic characteristics and psychiatric comorbidities in Alzheimer's dementia (AD) inpatients with manic episodes versus without manic episodes, and to evaluate the demographic predictors and risk factors for manic episodes in AD inpatients. Methods We conducted a case-control study using the Nationwide Inpatient Sample of 34,285 AD patients (age ≥60 years). Subsequently, the cases i.e., AD inpatients with a manic episode (N = 1,035) and the controls (without a manic episode, N = 1,035), were extracted using propensity-score matching based on age. The cases did not have a past psychiatric history of bipolar disorders. We used the logistic regression model to evaluate the odds ratio (OR) of association between pre-existing psychiatric comorbidities and manic episodes and evaluate the demographic predictors of manic episodes in AD inpatients. Results A higher proportion of AD inpatients with manic episodes were females (63.8%), whites (85.2%), and from low-income families below the 50th percentile (63%). Females were more likely to be hospitalized for manic episodes (OR 1.33; 95% CI 1.09-1.64) than males. AD inpatients with manic episodes had a higher risk of presenting with suicidal behaviors (OR 1.88; 95% CI 1.23-2.86). A significantly higher proportion of AD inpatients with manic episodes had comorbid tobacco use (5.3% vs. 3.4%) and cannabis use (1.4% vs. 0%) compared to those without manic episodes. Conclusion Females with AD had a greater risk of being hospitalized for manic episodes. These patients have an 88% higher risk of suicidal behaviors during the manic presentation and have comorbid tobacco and cannabis use. Early diagnosis and management of manic episodes in at-risk AD patients are important to improve the quality of life (QoL) and outcomes.
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Affiliation(s)
| | | | - Ripudaman Singh
- Internal Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sanobar Jaka
- School of Global Public Health, New York University, New York, USA
| | - Gagan Kaur
- Medicine and Surgery, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, IND
| | - Era Rawal
- Medicine/Cardiology, Norvic International Hospital, Kathmandu, NPL
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48
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Galvin JE, Chrisphonte S, Chang LC. Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults. J Alzheimers Dis 2021; 84:1563-1576. [PMID: 34690143 PMCID: PMC10731581 DOI: 10.3233/jad-215020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer's disease and related disorders (ADRD) health disparities. OBJECTIVE Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program. METHODS We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes. RESULTS African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel SES. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants. CONCLUSION SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lun-Ching Chang
- Department of Mathematical Sciences, Florida Atlantic University, Boca Raton, FL, USA
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